Physicians Practice - July/August 2008 - (Page 44)

PATIENT RELATIONS A UNIVERSAL PAIN THE FEARFUL PATIENT “These patients do take a lot of time and energy and we can end up exacerbating the whole thing by our response,” says Andrew Wolf, a general internist and associate professor at the University of Virginia School of Medicine, who holds regular seminars on dealing with tough patients. “One really does need to work on becoming an expert at treating these patients. They’re not going away.” The ﬁrst step, says Shakaib Rehman, associate professor of medicine at Ralph H. Johnson V.A. Medical Center at Medical University of South Carolina, is to recognize that it’s not necessarily the patient who is difﬁcult; rather, the situation makes them so. A large number of patients who express anger, for example, have not been given the right information at the right time. “Most experienced physicians realize that difﬁcult patients are not the same as say, someone with diabetes or hypertension,” says Rehman, who delivers workshops on doctor-patient communication. “You yourself can have a difﬁcult conversation with the phone company, and suddenly, it’s you who are difﬁcult.” The underlying cause of your patient’s irksome behavior may not in fact be what you think. Often, for example, it’s fear, which can drive an otherwise reasonable person to become overly emotional, quick-tempered, or disagreeable. “Patients don’t always feel in control in the doctor’s ofﬁce,” says James Welters, a family practitioner and chief medical ofﬁcer with Northwest Family Physicians, an 18-physician practice in Minneapolis. “They may be scared because of a previous interaction with a physician or something a family member experienced. Certainly, when you’re ill, you feel more vulnerable.” interruption while you maintain eye contact. Ask open-ended questions that encourage patients to provide more detail. “And how is this affecting your personal life?” can throw wide the gate of communication. Empathy is equally important, but it must be sincere. “Don’t say things like ‘I understand,’ because you really don’t know what they’re feeling,” says Welters. “It comes across as false. Instead, use phrases such as, ‘I understand from other patients who have had this condition that these are the things you might be feeling.’” IT’S INEVITABLE IN SUMMARY Difﬁcult patients aren’t necessarily difﬁcult people. By taking some time to discover the real reason a patient is misbehaving, you may ﬁnd ways to satisfy your patient as well as improve your practice: If you’ve been in practice for any amount of time, you’ve no doubt experienced the angry patient who walks in with a chip on her shoulder and unrealistic expectations on her mind. She finds fault with the medical profession in general and, often, with you, personally. When interviewing patients during exams, he says, it sometimes helps to simply ask them to describe their worst health concerns. “Sometimes their fear is something that wouldn’t even cross my mind, like a patient with a persistent cold who immediately thinks lung cancer,” says Welters. “Just telling them, ‘No, I don’t think that’s what it is,’ can put their mind at ease.” You can also help allay fears by improving your communication skills. That means focusing on your patient’s verbal and nonverbal cues (e.g., facial expressions, uncomfortable shifting). Allow them to speak without THE DRUG SEEKER • Identify the source of their frustration. • Let angry patients vent, and make sure you legitimize their feelings. • Bring somatizing patients in more often than they can come up with problems. dependent patients. • Set clear boundaries for emotionally • Dismiss verbally or physically abusive patients promptly. Some patients are difﬁcult to manage because they’ve become dependent on pain medication or another controlled substance. Often, these patients have a legitimate medical condition and are experiencing discomfort. Unfortunately, they become relentless in their pursuit of stronger drugs. “Some patients will go to great lengths to get them from you and others,” says Welters. “I had one patient who went from hospital to hospital saying she wasn’t getting pain medication or anti-anxiety medication or sleeping pills from her physician. Ultimately, she started forging her own prescriptions.” WWW.PHYSICIANSPRACTICE.COM 44 | PHYSICIANS PRACTICE | JULY/AUGUST 2008 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.